Provider Demographics
NPI:1346050150
Name:RUBY MEDICAL PRACTICE
Entity type:Organization
Organization Name:RUBY MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURALIDHARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-840-9834
Mailing Address - Street 1:1743 SIDEWINDER DRIVE
Mailing Address - Street 2:#114
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7322
Mailing Address - Country:US
Mailing Address - Phone:307-840-9834
Mailing Address - Fax:833-450-0933
Practice Address - Street 1:1743 SIDEWINDER DRIVE
Practice Address - Street 2:#114
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7322
Practice Address - Country:US
Practice Address - Phone:307-840-9834
Practice Address - Fax:833-450-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty